DESCRIPTION: This is a application submitted by the University of Minnesota, Russell Luepker, PI. The study, known as the Minnesota Heart Survey (MHS), has been ongoing since 1970. The MHS is among the few population-based longitudinal studies that are examining trends over time in the incidence and survival rates of acute myocardial infarction, out-of-hospital deaths due to coronary disease, and stroke. The overall objective of the competitive renewal of the MHS surveillance system is to continue to monitor and explain trends in the incidence, case- fatality, and mortality rates of coronary heart disease (CHD), acute myocardial infarction (AMI) and stroke, in a defined community, namely the seven county Minneapolis-St. Paul (Twin Cities) metropolitan area of Minnesota. Based on systematic data collection efforts beginning with the baseline year of data abstraction in 1970, the proposed research will enable the team of investigators to more fully understand the causes of observed incidence and mortality trends detected during the 1980s through the mid- 1990s. The proposed study is significant not only due to the importance of monitoring trends in the magnitude of, and mortality from, CHD in the U.S. and abroad, but also to assist policy makers, health care researchers, and clinicians in determining the relative contributions of primary and secondary prevention to declining CHD mortality rates. In addition, with the exception of the MHS, only extremely limited population-based data are available to assess prior as well as recent trends in the incidence and death rates from stroke. The assembled team is well qualified and has an excellent track record of achievement. However, there was some concern about a lack of physician expertise in stroke among the local investigators in Minneapolis. Dr. Whisnant, their consultant, is a highly respected and well-qualified neurologist located in Rochester, and cannot be involved in supervision of data abstraction nor in interpretation of imaging data.The majority of discussion concerning the overall application had to do with the stroke component of the study. There were three primary foci:(1) the need to add clinical neurological expertise to the team for more "hands-on" involvement; (2) the importance of including other ICD-9-DM categories of stroke, especially to include subarachnoid hemorrhage; and (3) the diagnostic algorithm, as proposed, does not include any systematic review of whether the imaging results themselves in contrast to the imaging reports, are consistent with the clinical examination. However, the reviewers felt that these and other issues were adequately addressed during the reverse site visit, and the investigators were quite responsive to the suggestions made for strengthening these aspects of the stroke component. Overall, the reviewers considered this to be an outstanding application with the potential to add significantly to the area of community surveillance research.